Martin McShane: Tipping point

January 30, 2012

The announcement last week of the design of the NHS Commissioning Board is critically important. It signals the end of the prolonged period of ambiguity which managers have experienced since the white paper was published in July 2010. For those who have been through the round robins of previous reforms there is a realisation that this time it is not about “rearranging the deckchairs.” Everyone is coming up hard against the fact that the way we have done commissioning in the past will not suffice in the future.

The board, the sectors, and the local offices will be much smaller than everyone is used to. They will need to, in fact be required to, make matrix management work. Indicating the functions, the structure, and the staffing sends out a clear indication of the scale of change and the likely impact this will have on individuals—which is when the major risks start to emerge. In our region alone about 500 SHA employees will be looking at the 50 posts to be had in the new structure and beginning to focus on what matters to them. Will there be a need for them in the future and, if so, where will that be?

At PCT cluster level it also means forging ahead with preparing for 2013. The design of the NHS commissioning board indicates what we need to have in place and allows clearer thinking about the next steps. This will have a cascade effect. By setting out the structures and posts for the NHS commissioning board, the staffing of commissioning support and clinical commissioning groups (CCGs) can be done with purpose and at a pace. We have a year to prepare for one of the most fundamental changes in the way commissioning works across the NHS. We are moving to a structure which, potentially, could function with greater conformity of strategy and intent. The implementation of that strategy will be strongly influenced and led by clinicians who see the system from where the majority of first contacts with patients occur.

There is, however that major risk. For weeks and months to come individuals will be wondering where their job will be or even if they will have one. There is a cadre of people with experience and skills who could be lost to the system. The CCGs need to take up the reins of commissioning implementation at a time when NHS providers are facing significant financial challenge.

It is going to be hard and difficult to manage this transition: fewer people to do the job, a lot of cynicism coupled with a great deal of anxiety makes some wonder if it is possible. Yet, last week I sat in a performance review meeting with our SHA. Two things struck me. Firstly the emphasis was on quality as much as, if not more than on money. That appealed to me as a clinician and seems to signal a real change from the centre. Secondly the CCG representatives were tangibly taking up the reins and responding to the challenges from the SHA. That gave me hope as a manager. My role is metamorphosing and transmuting into development and handover. From this April the CCGs need to be in the driving seat. In the same week we also appointed someone to lead on developing and establishing commissioning support for the CCGs. My directorate basically comprises two people, other than me, now! We have reached a tipping point where we need to swiftly build the new structures, give people certainty, and not lose grip on delivery. It does not feel like there will be any turning back.

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.

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